SPIKES Protocol
| Step | Action |
|---|---|
| Setting | Private room, sit down, support person present, no interruptions |
| Perception | Ask what the patient already understands |
| Invitation | Ask how much they want to know |
| Knowledge | Give a warning shot, then the news in plain language and small amounts |
| Emotions | Acknowledge and respond to emotion, allow silence |
| Strategy and summary | Agree a plan, next steps and follow up |
- Baile and colleagues, The Oncologist 2000
Orthopaedic Examples
- New diagnosis of malignancy
- Amputation
- Complications and poor outcomes, alongside open disclosure
- Failed limb salvage or the need for revision surgery
- Spinal cord injury and the outlook for walking
- Pathological fracture revealing metastatic disease
Practical Points
- Prepare by reviewing results and knowing the next steps
- Use plain words such as cancer rather than euphemisms
- Check understanding and offer written information
- Involve the cancer nurse, social worker or other team members
- Use an accredited interpreter where needed
- Arrange early follow up and document the conversation
- Sit down, avoid interruptions and hand the pager to a colleague
- Allow time for questions and offer a second meeting
- Debrief with the team after a difficult conversation
Fellowship Examination
- Communication scenarios often follow a SPIKES structure
- Examiners look for empathy, honesty and a clear plan
- Common scenarios include a missed diagnosis and a new malignancy
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.